Broward County Public SchoolsRevised: August 2007 Health Science Core Chapter 8 Disaster: Preparedness, Hazards, and Prevention Broward County Triage Broward

Broward County Public Schools Revised: August 2007

Health Science Core Chapter 8

Disaster: Preparedness, Hazards, and PreventionBroward County Triage

Broward County Incident Command


Chapter 18: Disasters: Preparedness


Disaster

An unexpected event that causes great damage and depletes or exhausts currently available resources

• Earthquakes• Hurricanes• Floods• Tornadoes• Airplane accident• Hazardous waste

accident


Triaging Terms

• Triage - To sort or prioritize care for a group of patients

• Assessment – evaluation of the patient• Objective – Information obtained from observing

the patient• Subjective – Information obtained from the

patient• The goal of triage – Prompt and efficient patient

care


Disaster Preparedness

1. Disaster preparedness has become a recognized specialty which requires cooperation of many agencies.

2. Proper preparation takes:• Foresight• Thought• Planning• Experience is the best teacher


Disaster Basic Guidelines

• Remain calm• Know who the designated person in charge of

you• Keep agency telephone lines clear for official

business• Communicate and cooperate with other workers• Always speak in a firm voice but a caring tone


Occupational Safety

• OSHA – Occupational Safety and Health Administration – agency that develops safety standards and establishes maximum levels of exposure to many hazardous material.

• NIOSH – National Institute for Occupational Safety and Health – Investigates requests of unsafe working conditions and how they relate to employee illnesses.


Hospital Hazards

• Anesthesia – gases used to cause loss of sensation and/or consciousness caused by the administration of drugs

• Radiation and chemotherapy – toxic substances that can have a high risk of developing tissue damage

• Asbestos – fireproofing material in old construction

• Always read the label and mixing instructions before using any chemicals


Hazard Communication / HazCom

Program that protects employees from the dangers of

chemicals and medical gases.

1. Employee training

2. Written program

3. Material Safety Data Sheets

4. Warning Labels


Mass Casualty Incidents Uniform Pre-hospital MCI Procedure


What is an MCI ?

Any Incident Which Overwhelms the Capabilities of the First Arriving Unit (s).


Predetermined Response

• Amount of resources that will automatically be issued based on the number of patients

• First responding unit will notify dispatch center the MCI Level

• There are 5 Levels of response


MCI Level 1 Response (5-10 Victims)

•

• 4 ALS Transport Units • 2 Suppression units• 1 Shift Supervisor

• 1 EMS Supervisor


MCI Level 2 Response (11-20 Victims)

• 6 ALS Rescue Units• 3 Suppression Units• 2 Shift Supervisors• 2 EMS Supervisors


MCI Level 3 Responses(21-100 Victims)

• 8 ALS Transport Units• 4 Suppression Units• 3 Shift Supervisors• 3 EMS Supervisors• 1 Operations Chief• 1 Command Vehicle• 1 Supply Trailer


MCI LEVEL 4 Response(101-1000 Victims)

• 5 MCI Task Forces (25 units)• 2 ALS Transport Unit Strike Teams (10 units)• 1 Suppression Unit Strike Team (5 units)• 2 BLS Transport Unit Strike Teams (10 units)• 2 Mass Transit Buses• 5 Shift Supervisors• 3 EMS Supervisors• 1 EMS Chief• 1 Operations Chief• 1 Command Vehicle• 2 Supply Trailers• 1 Communications Trailer


MCI LEVEL 5 Response(Over 1000 victims)

• 10 MCI Task Forces (50 units)• 4 ALS Transport Unit Strike Teams (20 units)• 2 Suppression Unit Strike Teams (10units)• 4 BLS Transport Unit Strike Teams (20 units)• 4 Mass Transit Buses• 10 Shift Supervisors• 6 EMS Supervisors• 2 EMS Chiefs• 2 Operations Chief • 2 Command Vehicles• 4 Supply Trailers• 1 Communication Trailers


First Arriving Unit Procedure


First Arriving

A. Unit Officer will establish “COMMAND”

1. Size-up and estimate number of victims

2. Request MCI level response

3. Identify a Staging Area


First Arriving

4. Initiate triage with crew members and initial crewsa. Perform START or JumpSTART Triageb. Prioritize victims

• REDRED (Immediate) (Immediate)• YELLOWYELLOW (Delayed) (Delayed)• GREENGREEN (Minor)(Minor)• BLACK BLACK (Non-salvageable)(Non-salvageable)

5. Direct walking wounded to one location


Mass Casualty Operational Structure


Operational Groups

1. Triage

2. Treatment

3. Transport

4. Staging


Basic Command Structure for Mass Casualty Incidents

Incident Commander /

Medical Branch Officer

Triage Group Treatment Group Staging GroupTransport Group


Other Possible Operational Groups

1. Medical Branch

2. Landing Zone

3. Extrication

4. Hazmat

5. Rehabilitation

6. Safety

7. PIO

8. Medical Intelligence


Complex Command Structure for Mass Casualty Incidents

Medical Branch

Triage Group Treatment Group Transport Group

Medical Supply

Triage Unit

Litter Bearers Unit

Medical Examiner Unit

Red unit

Yellow Unit

Green Unit

Staging

Aid

Medical Communication

Coordinator

Aid


START Triage


Initial Triage

• Locate and direct all walking wounded

• Assign someone to keep green group together

• Assess non-ambulatory• Use colored ribbons tied to

upper extremity• Borderline use higher priority

tag


• Perform during Treatment phase

• Use DMS All Risk Triage Tag

• Trauma criteria will apply

Secondary Triage Procedure


Respirations

Perfusion

Mental

Adult START TriageRPM


• Less Than 30/minute – Go To Perfusion• Over 30/Minutes – RED Tag• No Respirations – Open Airway:

– Breathing – RED Tag

– Not Breathing – BLACK Tag

Respirations


• Radial Pulse present or Capillary Refill is < 2 seconds -

Go To Mental Status

• No Radial Pulse or Capillary Refill > 2 Seconds – RED Tag

Perfusion


• Follows Simple Commands & AAOX3 – GREEN

• Does not follow commands, not AAOX3 or is Unconscious – RED Tag

• Depending on Injuries – YELLOW Tag

Mental Status


START Flow Chart


Pediatrics Jump START Triage


JumpSTART Triage

Triage system adapted for pediatrics < 8 years old, which use a modify version of

evaluating:

• Respiration• Perfusion• Mental Status


Respiration

• Rate between 15 and 45 BPM –

Go to Perfusion• Rate over 45 BPM or under 15 BPM – RED Tag • No Respiration –

• Open Airway and remove any obstruction• Still no breathing, than check radial or pedal pulse• No pulse - BLACK Tag• Pulse present Give 5 respirations –

• Breathing begins – RED Tag• No breathing – BLACK Tag


Perfusion

• Peripheral pulse present –

Go to Mental Status• Peripheral pulse absent –

RED Tag


Mental Status

Assess child with AVPU Scale

(Alert, Verbal, Painful, or Unconscious)• If unconscious or only responds to

painful stimuli –

RED Tag• If child is alert or responds to verbal

stimuli assess for further injuries -

YELLOW Tag or GREEN Tag


JumpSTART Flow Chart


Secondary Triage with All Risk Triage Tag


All Risk Triage Tags


Contaminated Section

• Must remove if patient is not contaminated

• If strip is not remove patient is considered contaminated.


Contaminated Section

• When the patient’s cloths are removed, the strip should be placed in the bag for evidence


Back

Front

1 watch, 2 rings, and 1 wallet

Personal Property Receipt

• Patient valuables in plastic bag


Personal Property Receipt


Front

Back

HMWR19

John Smith

Patient Ground Transport Tracking Tag

• Removed by Transport Officer for patient tracking


Chemical Exposure Symptoms and Treatment

• Salivation• Lacrimation• Urination• Defecation• G.I. Distress• Emesis• Miosis

X X

Mark 1

X


Patient Assessment

• Decontamination

• Area of injury

• WMD type

X

28

X

XX


Vital Signs

• Documenting B/P, Pulse, Respiration, and IV solution

11:30 180/78 120 14

11:30 Normal Saline KVO


Triage Category

• Remove all of the tags distal to desires color and half of the color.

• Above is Yellow Tag


START Triage Method

X XX

X


Personal Information

John Smith

14801 SW 27 Street

Miramar FL 33027


References

• Stevens, Kay, and Garber, Debra. Introduction to Clinical Allied Healthcare. 2nd ed. Clifton Park, New York: Thomson Delmar Learning, 1996.

• Jones and Bartlett Publishers. (2004). Florida Regional Common EMS Protocols, Sudbury, MA: Jones and Bartlett.

Documents

Broward County Public SchoolsRevised: August 2007 Health Science Core Chapter 8 Disaster: Preparedness, Hazards, and Prevention Broward County Triage Broward